Prescription drug abuse has become an epidemic in Montana

May 05, 2013, Missoula, MT 
Of all the substances Sam Martinez has abused – and there have been many – pills were the easiest to score.

She just went to her usual dealers: old people.

“A lot of elderly people that need extra money and that don’t use all their meds sell them,” said Martinez.

Martinez, 26, has abused various substances, starting with marijuana, since her teens. For a while, she smoked weed and used meth and pills daily.

She knew the dangers of meth. “Not even once,” she said, parroting the theme of the Montana Meth Project’s in-your-face ads.

But when it came to pills, not so much. Prescription drug abuse tiptoes under the radar, cloaked in the white-coated respectability of a doctor’s office or pharmacy.

“The biggest problem we have to overcome is (the attitude that), ‘It’s just a pill. ... It’s safe. It’s prescribed by a doctor. It’s not being made in a truck in the backwoods,’ ” said Missoula Police Detective Dean Chrestenson, the department’s first full-time prescription drug diversion detective.

The problem cuts across age and class, from honors students chasing better test scores to junkies chasing a high that became more elusive during the meth crackdown. Doctors tend to addicted newborns whose mothers used, and also nursing home patients who popped Valium in the ’60s and now maintain their addictions with painkillers.

“We’ve had older couples drive from the north side of the state to Missoula to sell pills ... and young people in high school trading pills they get from home,” Chrestenson said.

Coroners deal with the worst cases, a sad statistic whose numbers have risen steadily since 2000.

Missoula County’s cavernous evidence locker is awash in pills, a majority of them from coroner cases, said Missoula County Sheriff’s Detective Jason Johnson. Pills didn’t cause all of those deaths; because of the danger that the medications will fall into the wrong hands, though, law enforcement officials now routinely confiscate prescription drugs from the scene of an unattended death.

“They’re probably the deadliest medication out there,” said Dr. Marc C. Mentel, medical director for the Community Physician Group at Community Medical Center.

Martinez herself said that “I can’t believe I’m still alive, some of the things I’ve done.” She described taking 30 milligrams of the attention deficit hyperactivity disorder medication Adderall just to get herself out of bed in the morning, and then meth and pills – the painkiller Lortab, say – the rest of the day, a mix-and-match combination that left her feeling like her “heart would explode.”

And nothing, not even meth, has a worse comedown, she said of the sweats and chills, vomiting and diarrhea, that the innocuous-looking pills produced.

Worst of all, she said, nothing has been harder to kick.

“I still have dreams about using – and being caught,” said Martinez, clean nine months now – which is a good thing, given that she’s six months pregnant.

Nationwide, said Mentel, the prescription drugs whose use rose sharply a decade ago as physicians with the best of intentions tried to better deal with patients’ pain now claim more lives each day than the number of American soldiers killed daily in the Vietnam War.

“You see what Vietnam did to mobilize a nation,” he said.

Yet when it comes to prescription drugs, there’s no public outcry, no protest marches.

“It’s a silent epidemic,” said Mentel, who’s working on a citywide program to persuade doctors who prescribe painkillers to sign contracts with their patients to help prevent even inadvertent abuse.

Over the past few weeks, reporters from the Missoulian and KECI-TV have interviewed physicians and law enforcement officers, students and counselors, addicts battling their disease and the families of those who lost that battle.

Here’s what they found:

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The schools

Unlike street drugs, prescription drugs are government tested and approved, which is one reason teenagers find them so appealing. Missoula teens say if you know what you have, you can research the drug and find out what other drugs may mix well for an intended result.

During finals, some students like to get amped up for the testing onslaught. Many turn to Adderall, which makes “you feel like a superhero for two hours,” explained Hellgate High School student Collin Dyer.

Academic demands and the pressures of an unknown future are a heavy burden, Missoula teens say, which is why many kids choose to find a way to relax and numb the mind. It’s not hard to do when so many people are prescribed painkillers and mood-regulating medications.

Melody Barnes, a longtime Missoula addiction counselor, has seen a dramatic rise among teenagers who use and abuse prescription drugs.

“We have a crisis,” she said of Missoula and the nation.

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College

The good news is that addiction to narcotic prescription drugs is no higher among college students than the general public.

That’s according to Mike Frost, interim director for counseling services at the University of Montana’s Curry Health Center.

The bad? Misuse of prescription drugs is highest among young adults ages 18 to 25 – those of college age – with nearly 6 percent reporting they’ve used prescription drugs for nonmedical use, according to the National Institute on Drug Abuse.

“I’ve heard of friends using Adderall if they’ve got a big paper due,” said student Hank Stein. “They’ll get some, and it helps them concentrate. I think it’s pretty easy to find.”

A decade ago, it was a rare occurrence for a student to seek help from Curry for prescription drug addiction, Frost said. Now, Curry sees about three students a semester who are trying to recover, he said.

“We’re making more referrals like that,” Frost said. “It’s not a large number, but it’s more than what we’ve seen in the past.”

Actually, said Diane Jordan, the interim director for Curry’s Self Over Substance program, “it’s rare for a student to come to us saying they need help. They’re usually poking around for more drug-seeking behavior. We have to screen for that.”

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Law enforcement

It’s been four years since the Missoula Police Department, in response to the burgeoning problem of prescription drug abuse, named Chrestenson as its first full-time prescription drug diversion detective.

What’s changed in that time?

“I’d say it’s stayed essentially steady,” Chrestenson said.

Which means very busy indeed. From people robbing pharmacies at gunpoint, to people swiping drugs from medicine cabinets when real estate agents hold open houses, from high school kids holding “Skittles parties” where they toss multicolored pills into a bowl, to dealers running some very profitable enterprises, law enforcement faces a frustratingly multifaceted problem.

It can be like a game of Whac-A-Mole. Crack down on meth, deal with a rise in prescription drug abuse. Turn your attention to prescription drugs, watch heroin regain popularity, Chrestenson said.

Still, he feels the effort is worth it.

“One attorney told me, ‘Yours is the only drug that’s killing people,’ ” he said. “That’s why we take it so seriously. ... Bottom line is, we’ll save lives. That’s the whole point of this.”

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Drug registry

Prescription drug abuse presents almost as many problems for pharmacists as it does for the police.

People seeking drugs either to use or to sell hold up their stores, or come in with forged prescriptions – or with real ones they’ve obtained by doctor-shopping. Sometimes pharmacists themselves, or their assistants, are addicted. All of those kinds of cases show up with depressing regularity on local court dockets.

As if that weren’t enough to deal with, pharmacists have a new challenge: complying with the demands of the prescription drug registry approved by the 2011 Montana Legislature.

The registry monitors certain addicting prescription drugs such as opiates and narcotics, and requires pharmacies to report weekly on the prescriptions they fill for controlled substances.

It’s a demand some pharmacists say they welcome.

“Prescription drug abuse is a real problem in America. ... If physicians use (the registry) like it was meant to be used, it should really help the people of Montana,” said Ross Roadarmel, a pharmacist at Lolo Drug.

With just a few clicks, a pharmacist now can check whether a patient is filling prescriptions elsewhere in the region. A recent check, for instance, revealed a woman who was filling prescriptions at pharmacies from Kalispell to Hamilton.

The woman in question is now in rehab – another advantage to the registry, Roadarmel said:

“You can spot abuse and you can also spot who needs help.”

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Worst-case scenario

Caitlin Stanich didn’t need anybody to point out that she needed help.

She knew.

She went to rehab, both inpatient and outpatient, court-ordered and on her own. In fact, she’d taken a month off work for a renewed attempt to get clean of the prescription drug addiction that had dogged her since high school when she relapsed in March, this time fatally.

Stanich grew up in Stevensville, but was living in Missoula when she died. The saddest thing is that no one in her family was surprised.

“I think maybe this is it,” her sister, Heather Montes, said she told her husband the day her father called and asked her to come home right away.

Sam Martinez knows Stanich’s fate could have been her own. Now that she’s clean, she sees the toll her addiction took on her mother, who worried daily about getting a call that her daughter was dead.

“My mom is so different with me now. She sleeps at night. She’s happy,” said Martinez.

But at the age of 26, Martinez has already seen prescription drug addiction claim the lives of five of her friends, all about her own age. Another friend sold drugs to someone who overdosed, and now faces a homicide charge, she said.

“It’s horrible, but at the same time it gives me motivation to want to be better and help people,” said Martinez, who’s majoring in addiction treatment at the University of Montana.

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Treatment

Through an initiative that focused on pain management, Montana and the Missoula community put the spotlight on prescription drug abuse a few years ago and ushered in revisions to various pain policies and practices at health care facilities.

Now, patients, families and even doctors are more educated, according to clinicians working in the field of addictions. And just last month, Recovery Center Missoula opened its doors to treat adults with chemical dependency and mental health illnesses.

Until it opened, people in western Montana had to travel to Billings or Warm Springs for treatment. Now, they can seek help closer to home.

But gaps in treatment remain. For one thing, the recovery center was slated to be full the first month it opened, according to Tammera Nauts, executive director.

It has 16 inpatient beds, the phones are ringing with people calling for admissions, and Nauts said one great need is simply for more beds.

“It is just really kind of jaw-dropping,” said Nauts.

So far, education about the issue has focused largely on the professionals who deal with it, not the general public whose members might become addicted.

That needs to be expanded, and fast, said Sam Martinez, the recovering addict.